Severe disseminated Talaromyces marneffei infection in idiopathic CD4 lymphopenia

Idiopathic CD4 lymphopenia (ICL) is a rare non-HIV-related syndrome, characterized by a reduced CD4 T-cell count and a predisposition to various opportunistic infections. However, Talaromyces marneffei (TM) infection has rarely been reported in ICL patients. Here, we report a previously healthy 48-year-old male patient who presented with fever, headache, fatigue, vomiting, and poor appetite. Mycological cultures from blood, bone marrow, liver and spleen were positive for TM. The immunodeficiency evaluation revealed a CD4 T-lymphocyte count of 32 cells/μL, with a negative HIV test. After receiving co-treatment with amphotericin B and voriconazole, the patient showed clinical improvement. At 1-year follow-up, the CD4 T-cell count remained decreased despite the complete resolution of symptoms. The appearance of disseminated TM infection in non-HIV patients should prompt an investigation for the possibility of ICL, as the clinical manifestations can be severe.